P2.O293: Medication Reconciliation: Interventions to Increase Completion in a Pediatric Residency

Purpose/Objectives: Medication reconciliation is the process of compiling a patient’s medications from all sources (patient chart review, pharmacies) creating a layer of patient safety against medication errors, interactions, and redundancies. At our center, medication reconciliations are completed by physicians, but are typically completed by a pediatric resident upon admission. We noted some discrepancies in home medication reconciliations during admission and found low reconciliation completion overall. In order to increase medication reconciliation completion we implemented a series of interventions. The objective of the study was to achieve a completion rate of at least 80% of medication reconciliations by 24 hours of admission.

Design/Methods: A chart review was performed 9/2/2022 to 2/3/2023 and a baseline was established that demonstrated 30% of medication reconciliations were completed by 24 hours of admission. A series of PDSA cycles were conducted with interventions including resident education during weekly resident didactics, attending faculty discussion during weekly pediatric hospital medicine division meetings, and the addition of physician workflow check marks in the electronic medical record. Interventions began in April 2023 and data was collected every 2 weeks through Tableau until 2/2/24. The data was compiled and analyzed in a run chart with changes in the median noted after each intervention.

Results: Following the first intervention through resident education on 2/3/23, there was an increase in the median from 30% to 50% medication reconciliation completion. With the second intervention through attending faculty discussions on 4/14/23, there was a subsequent increase in the median from 50% to 82%. A median of 82% was maintained during the 3rd PDSA cycle with the addition of medication reconciliation checkmarks in the electronic medical record from 4/14/23 to 2/2/24. Overall, there was a change in the median from a baseline of 30% completion of medication reconciliations by 24 hours of admission to 82% by the end of the project on 2/2/24.

Conclusion/Discussion: An increase in the median completed medication reconciliations was noted after each intervention was implemented, with the exception being the list check mark. Completed medication reconciliation was at goal at the start of the 2023 academic year but began to fall below goal by August. This dropoff may be due to inpatient resident turnover and lack of reminders over time. Later low points coincide with respiratory season and may be due to higher patient volumes. This suggests that while the interventions implemented were successful in increasing medication reconciliation completion, over time new interventions aimed at reminding residents or streamlining of the medication reconciliation process may be needed.